09-21-2017, 02:05 AM
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AAPC Community Wiki: sepsis with uti E. coli

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sepsis with uti E. coli

Question for you sepsis experts. Pt has SIRS/sepsis due to UTI with E. Coli. The urine culture is E. coli. No mention or connection to the blood. Not stating sepsis due to E. Coli.
So you code
038.9 unspecified septicemia
599.0 UTI
995.91 Sepsis
Now, if you want to put the organism for the UTI E. Coli 041.4, you get an edit saying this is excluded with 038.9.
My question is, do you just not code the organism for the UTI?

i would look for other indicators of sepsis before i would code sepsis since often they mean urosepsis and not sepsis per se. does patient have any organ failure, tachycardia, fever, leukocytosis, etc....i look at the whole picture you want the record to "show" that the patient is truly septic. Hope that helps...if in doubt i would query the doctor especially in absence of positive blood cultures however they can be sterile and still the patient can be septic.

If you have an organism specified then you code the organism documented and not the 038.9. Then the sepsis and then the UTI. Check the coding guidelines, the sepsis is the systemic infection due to the organism and the UTI is the localized infection due to the systemic infection.

The patient definitely has sepsis. I have an organism, but the organism is for the UTI.
So, if they list diagnoses like this:
Sepsis due to UTI.
UTI due to E. coli.
You are saying that I code the sepsis as E. Coli sepsis? 038.42?

My question is since they don't connect the E. Coli to blood, as in saying, sepsis DUE to E. Coli, I don't feel I can code it as sepsis due to do E. coli and that the organism is only connected to the urine. Thanks for your help.

If the sepsis is due to untreated UTI and the organism which cultures out is in fact E coli which is documented as the cause of the UTI, then the Sepsis is the systemic infection caused by the offending organism at the root of everything. So if you want to follow this timeline then there was the E coli which sat there and festered, then produced the UTI which the owner did not treat and it festered which then created the whole body septic condition. We code the offender first, that would be the E-Coli followed by the systemic which is the Sepsis followed by the localized which is the UTI.

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